KMAP BULLETIN: CMS PERM Program Review Process

Date: 10/26/20

KMAP GENERAL BULLETIN 20223 (PDF)

The Centers for Medicare & Medicaid Services (CMS) Payment Error Rate Measurement (PERM) program measures improper payments made in Medicaid and the Children’s Health Insurance Program (CHIP) and produces error rates for each program. The error rates are based in part on reviews of Medicaid and CHIP fee-for-service (FFS) claims in the state fiscal year (SFY) under review. The State of Kansas is a participant for SFY 2021 in the PERM review.

The CMS review contractor, NCI Inc., will be directly contacting a random selection of Kansas FFS providers in order to request medical documentation to substantiate claims payments made in SFY 2021. The CMS review contractor will provide PERM training through webinars for providers selected to participate. The Kansas Department of Health and Environment (KDHE) will inform providers when these trainings are scheduled and keep providers updated regarding the PERM processes.

In preparation for the potential of being selected, each provider should identify a PERM coordinator for their office. A PERM coordinator is the designated person to facilitate provision of medical record requests.

Medical record requests are consistent with the mandatory compliance statement contained in all Kansas Medical Assistance Program (KMAP) provider agreements stating, “The provider agrees that routine reviews may be conducted by the Department of Health and Human Services, the State Medicaid Authority (SMA), or its designee of services rendered and payments claimed for KMAP consumers and that during such reviews the provider is required to furnish to the reviewers records and original radiographs and other diagnostic images which may be requested. If the required records are retained on machine readable media, a hard copy of the records must be made available when requested.”

Promptly supplying the information requested by the CMS contractor reduces the number of error findings and decreases the potential recoupment of claims.

Additional information about the PERM program is available on the PERM page of the CMS website at the Providers link on the left.

KDHE appreciates the collaboration of providers during this review.